| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
635 |
562 |
$109K |
| 00812 |
|
15 |
12 |
$2K |
| A4649 |
Surgical supply; miscellaneous |
63 |
39 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
26 |
22 |
$120.45 |
| E1399 |
Durable medical equipment, miscellaneous |
66 |
39 |
$105.58 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
25 |
21 |
$61.35 |
| A4615 |
Cannula, nasal |
59 |
38 |
$12.32 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
66 |
39 |
$4.97 |
| A4215 |
Needle, sterile, any size, each |
65 |
38 |
$0.18 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
35 |
18 |
$0.06 |
| 99070 |
|
61 |
35 |
$0.00 |